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'MVP' Care for Aspiring All-Stars

Taking care of elite athletes means better sports medicine care for all of us

Sam Pirtle is itching to get back to wrestling. Faced with the exciting possibility of sports scholarships, the 16-year-old honors student at Roxanna High School in Illinois was on track to be recruited for college wrestling teams when he injured himself last fall.

"Sam’s currently ranked among the top students in Illinois for his weight class in wrestling," says mom Kelley. "He torqued his shoulder in an odd position during a tournament. It became so inflamed that he couldn’t lift his arm or it popped out of the socket."

Sam was reluctant to undergo surgery because he might miss the spring state wrestling tournament, where most teens are noticed for scholarships. He came to the Washington University sports medicine specialists at Barnes-Jewish Hospital to explore other options.

"The doctors understood Sam’s goals and recommended an aggressive four-day-a-week therapy program to re-build muscle strength and improve his range of motion while also focusing on injury prevention," says Kelley. "They really took into account not only Sam’s passion for the sport but also how to get him back to a level where he could compete safely."

Sports medicine encompasses a wide range of medical fields, from orthopedics to cardiovascular medicine. Far from focusing only on professional athletes, sports medicine focuses on the care of all active individuals — anyone from children to older adults.

"The vast majority of the patients we see are youth involved in competitive sports or weekend warriors who get hurt at work or play," says Rick Wright, MD, Washington University orthopedic surgeon and co-chief of sports medicine at Barnes-Jewish Hospital. "But what sets us apart is that we do care for some of the best professional athletes in the region, which allows us to take that knowledge and skill and help all of our patients recover and return to their activities as quickly and easily as possible."

At Barnes-Jewish Hospital, Washington University orthopedic surgeons serve as team physicians for the St. Louis Rams football team and the St. Louis Blues hockey team. Several physicians also work with colleges and high schools. There’s even a former professional soccer player on staff— orthopedic surgeon Robert Brophy, MD — available to see patients with active lifestyle injuries.

"I’m now the ‘weekend warrior’ myself trying to stay active while having a busy career," says Brophy.

"I think all of us in sports medicine understand the mindset of someone who is active at any level and can help them get through an injury and back on track."

Matthew Smith, MD, specializes in throwing injuries. "I played sports in high school," he says. "I suffered a shoulder injury that resulted in surgeries both in high school and right after college, so I have personal experience in treatment, recovery, and in how determined some patients are to get back in top shape."

Smith has an advanced expertise in shoulder and elbow injuries specifically related to throwing, having completed a focused fellowship on the Throwing Athlete and Sports Elbow at the American Sports Medicine Institute in Birmingham, Ala. "It’s a unique area in sports medicine and one that’s growing because of the trend toward year-round participation in a single sport, which brings with it the increased potential for injuries," he adds.

"In addition to focusing on treatment, I’m also committed to educating trainers, coaches and families on how to prevent such injuries in the first place."

Along with prevention and treatment, Smith says actually managing injuries is critical for any athlete, young or old. "We spend a lot of time counseling them on timing — what they need to do and when — so that we can best develop a rehabilitation and injury prevention program that keeps them as active as possible throughout their season while also keeping them safe. That’s what we’re doing with Sam. We are working to get him ready for his upcoming tournaments."

A thorough physical is the foundation for anyone seeking an active lifestyle or who is involved in competitive sports. Not only can an exam identify potentially career-ending orthopedic issues, it also can catch hidden problems.

More Than Just Orthopedics

Earlier this year, pro football was rocked when Chicago Bears’ defensive end Gaines Adams, age 26, died of sudden cardiac death. Among many heart doctors, though, Adams’ death came as no surprise. An estimated 75 young athletes die each year from hypertrophic cardiomyopathy (HCM), a heart problem that often is difficult to diagnose. Suspected as the cause of Adams’ death, HCM occurs in one in 500 individuals and is the most common genetic cardiovascular condition.

"Patients usually have either chest pain or shortness of breath, and some of them will have palpitations," explains Keith Mankowitz, MD, director of the HCM clinic at the Heart & Vascular Center. "If patients are not counseled on it and then overdo exercise activities, they can be at risk for dying. They need specific management guidelines and treatment protocols in order to live a fruitful and long life."

Robert W. Thompson, MD, receives gifts from grateful patients, including from a ballerina who recently had surgery for her TOS.

Also potentially life-threatening or limb-threatening is a condition known as thoracic outlet syndrome (TOS). Caused when a nerve or blood vessel in the shoulder is pinched or compressed, TOS has been found in active individuals who perform repetitive and strenuous upper-arm movements. While nerve compression symptoms, such as pain, numbness, and tingling, build up over time, patients with blood-vessel compression may require immediate treatment for any blood clots or aneurysms that could develop.

Only a few centers in the country specialize in TOS, and the Center for Thoracic Outlet Syndrome at Washington University School of Medicine and Barnes-Jewish Hospital is now considered a leading authority on TOS diagnosis and treatment, seeing more than 150 patients last year alone.

"Some of our patients have undergone long series of medical tests or surgery for neck compression or carpal tunnel without relief," says Robert W. Thompson, MD, a vascular and general surgeon who founded the center and organized the first national symposium entirely focused on TOS in the fall of 2009. "What they find here is a team of professionals — from physicians and nurse practitioners to physical therapists — who follow specific protocols depending upon the type of TOS diagnosed."

"I was really discouraged because my symptoms went on for years," said Bryan Bopp, an Illinois computer consultant who suffered from constant pain, dizziness and vertigo. "It affected my work and my home life, and I didn’t even want to play with my sons anymore."

Nerve conduction studies finally done by a physician came back abnormal, and Bopp was referred to Thompson, who found that Bopp was among the .5 percent of the population born with an extra rib extending from a cervical (neck) vertebra. The extra rib compressed a nerve, causing pain. Bopp also had developed an aneurysm behind it.

After surgery, Bopp says, "My limited range of motion and neck pain were gone. I now live life the way it should be with my family, and I’m free of pain."

Thompson, who has treated everyone from baseball players and nationally recognized ballerinas to waitresses and computer workers such as Bopp, says detective work is crucial to uncovering a diagnosis. "We have to look at all the symptoms and evaluate a patient’s movement and blood flow as well as the results of nerve conduction studies," he says. "It’s like a puzzle, and we work to find the missing pieces to effectively treat a patient in pain."

Active Patient Research

With widespread expertise in sports medicine, the Washington University physicians at Barnes-Jewish Hospital are engaged in multiple innovative clinical trials evaluating the effectiveness of treatments and gauging the risk of recurrent injury.

They also keep a constant watch for injury trends that not only affect professional athletes, but also the weekend warrior.

"We are always on the leading edge of sports medicine because of our association with elite athletes, whether through our research activities or clinical care," says Wright. "The knowledge we gain can then be used with all patients to help them achieve their goals. With a wide range of options, including non-surgical therapies, minimally invasive procedures and comprehensive rehabilitation, our patients recover and return to activities as quickly and easily as possible. That way, they don’t have to remain on the sidelines of any activity."